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  #1  
Old 11-14-2017, 12:04 PM
Brizzle Brizzle is offline
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Default CMS MMR data help

Hi everyone,

I work in the MA field, and I am trying to work with the CMS MMR reports. I'm having a lot of trouble finding resources on specific nuances of the report (like which adjustment reason codes exclude which data flags and why).

Can anyone recommend a good learning resource? After scouring the CMS website, I find a lot of general info, but nothing about specific cases. I am trying to create a member table with accurate demographic flags, but in some cases I can't tell which of the ARCs provide accurate flag data and which ones are incorrect flag data.

Thanks!
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Old 11-14-2017, 12:40 PM
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BruteForce BruteForce is offline
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Good luck. The MMR is a hard table to work from. I usually just use it to pull in revenue for the Mid-year and final payments. I don't use it for membership counts.

Do you have the document that tells you what the different adjustment reason codes mean? That was a big help for me once I got it.
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Old 11-14-2017, 02:43 PM
Brizzle Brizzle is offline
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Quote:
Originally Posted by BruteForce View Post
Good luck. The MMR is a hard table to work from. I usually just use it to pull in revenue for the Mid-year and final payments. I don't use it for membership counts.

Do you have the document that tells you what the different adjustment reason codes mean? That was a big help for me once I got it.
Yea, I've got that one, and it does help to sort out most of the data. It's just certain topics that I'm not sure on. I may end up submitting specific questions to CMS and just waiting the 4 months or so for a response.

Example: Prospective payment comes in, Member in county A. ARC 37 (PD adjustment) comes in for that same month and shows member in county B. Member is in county B in future months, but I never received an ARC 11 (county change) for that specific month. Is the county from the PD adjustment correct for the month in question, or is the original county correct?
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Old 11-14-2017, 03:16 PM
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BruteForce BruteForce is offline
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I went to the SOA Medicare Pricing bootcamp a few years back. I remember the teacher saying that CMS has 3 membership files (don't remember what they all are, but I know the MMR was one of them) and that they never agree with each other. Doesn't surprise me that you find discrepancies like that within the MMR.

With that stuff, we usually just go with our internal data.
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Old 11-14-2017, 03:30 PM
Brizzle Brizzle is offline
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Originally Posted by BruteForce View Post
I went to the SOA Medicare Pricing bootcamp a few years back. I remember the teacher saying that CMS has 3 membership files (don't remember what they all are, but I know the MMR was one of them) and that they never agree with each other. Doesn't surprise me that you find discrepancies like that within the MMR.

With that stuff, we usually just go with our internal data.
Good to know BF, thanks! So, do you guys have any way to audit the revenue you are getting (checking the MMR vs your internal data?) Or do you just assume it is 99% correct and the incorrect parts are a wash (sometimes more/sometimes less revenue)
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Old 11-15-2017, 10:10 AM
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This has the file layout and the meanings of all the code fields, for all the data feeds, not the just the MMR.

They update it usually once every one or two years.

https://www.cms.gov/Research-Statist...ry-28-2017.pdf
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Old 11-15-2017, 10:47 AM
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BruteForce BruteForce is offline
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Good to know BF, thanks! So, do you guys have any way to audit the revenue you are getting (checking the MMR vs your internal data?) Or do you just assume it is 99% correct and the incorrect parts are a wash (sometimes more/sometimes less revenue)
I think someone somewhere in the company audits the file, or at least I'd like to think that happens. I'll probably just keep assuming that happens, because I don't want to know if it isn't
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